Engaging PCPs to optimize active surveillance of low-risk prostate cancer

项目总结 老年和复杂医学的癌症患者人数呈指数级增长，呼吁 初级保健提供者(PCP)参与基于团队的模式，为癌症提供高质量的护理 整个过程中的患者。鉴于诊断率的快速增长，基于团队的护理尤为必要 低风险癌症(如前列腺癌、甲状腺癌和乳腺癌)。不仅这些患者通常年龄较大，而且 更多的合并症，但治疗策略正越来越多地从手术和放射转向积极 监视系统。因为低风险前列腺癌指南现在建议积极监测 作为初级疾病管理战略的一部分，它是研究如何更好地利用初级保健计划的理想案例。一个 PCP参与可以帮助的关键差距是提高对主动监测的遵从性；尽管 许多男性正在选择这一策略，但一旦选择，坚持主动监视仍然是次优的。 因此，了解如何支持患有低风险前列腺癌的男性最大限度地遵守 积极的监测，以及重要的是，如何有效地让初级保健医生参与低风险癌症管理。 Radhakrishnan博士的长期职业目标是成为一名独立的临床医生-研究员，专注于 优化PCP在癌症连续统一体的基于团队的护理提供中的作用。她把注意力放在了低- 鉴于及时和迫切需要满足越来越多的低收入人群的需求，癌症风险管理 癌症患者的风险。利用密歇根泌尿外科手术改进协作组(MUSIC)，这 该项目的目标是：1)描述提供者和患者对主动监测遵从性的看法；2)设计 以患者为中心的干预，使提供者能够支持男性进行主动监测，以最大限度地提高 坚持；以及3)对初级保健和泌尿外科的关键结果进行干预的试点评估 练习。这项工作的成功完成，以及随后的R01研究，将改善低风险癌症 通过开发整合到初级保健提供系统中的以患者为中心的干预措施来进行管理。 Radhakrishnan博士寻求在她作为儿科医生的临床背景和她的研究奖学金培训的基础上再接再厉 获得更多的技能和经验，以实现她的长期职业目标。和她的指导团队一起，她 已经制定了全面的职业发展计划，将支持她：1)完成培训 目标，并在干预设计、评估和培训方面具备较强的定性方法和专业技能 执行；和2)从事职业发展活动，使她能够过渡到独立 一名临床医生兼调查员。她将得到一个由专职导师和顾问组成的多学科团队的支持， 谁将监督广泛的课程作业和体验式学习，并致力于确保 成功。此外，密歇根大学为Radhakrishnan博士提供了理想的环境 Proposal，凭借其非凡的资源和一支出色的指导团队，在开发方面取得了成功 初级临床医生-科学家。

PROJECT SUMMARY The population of older and medically complex cancer patients is growing exponentially, calling for the involvement of primary care providers (PCPs) in team-based models to deliver high-quality care to cancer patients across the continuum. Team-based care is especially needed in light of the rapid growth in diagnoses of low-risk cancers (such as prostate, thyroid, and breast). Not only are these patients typically older and with more comorbidities, but treatment strategies are increasingly moving away from surgery and radiation to active surveillance. Because guidelines for low-risk prostate cancer now recommend active surveillance as the primary disease management strategy, it represents the ideal case for studying how to better engage PCPs. A key gap where PCP involvement can help is in improving adherence to active surveillance; though a growing number of men are choosing this strategy, adherence to active surveillance once chosen remains suboptimal. Thus, it is critical to understand how to support men with low-risk prostate cancer to maximize adherence to active surveillance and importantly, how to effectively engage PCPs in low-risk cancer management. Dr. Radhakrishnan’s long-term career goal is to become an independent clinician-investigator focused on optimizing the role of PCPs in team-based care delivery across the cancer continuum. She is focusing on low- risk cancer management given the timely and critical need to meet the demands of the growing number of low- risk cancer patients. Leveraging the Michigan Urological Surgery Improvement Collaborative (MUSIC), this project aims to: 1) characterize provider and patient perspectives on active surveillance adherence; 2) design a patient-centered intervention that enables providers to support men on active surveillance to maximize adherence; and 3) perform a pilot evaluation of the intervention on key outcomes at primary care and urology practices. Successful completion of this work, and subsequent R01 studies, will improve low-risk cancer management by developing a patient-centered intervention integrated into primary care delivery systems. Dr. Radhakrishnan seeks to build upon her clinical background as a PCP and her research fellowship training to acquire additional skills and experiences to achieve her long-term career goal. With her mentoring team, she has developed a comprehensive career development plan that will support her to: 1) accomplish her training aims and develop a strong skillset in qualitative methods and expertise in intervention design, evaluation, and implementation; and 2) engage in career development activities to enable her to transition to independence as a clinician-investigator. She will be supported by a multidisciplinary team of dedicated mentors and advisors, who will oversee a broad range of coursework and experiential learning, and are committed to ensuring her success. Additionally, the University of Michigan offers Dr. Radhakrishnan the ideal environment for this proposal, with its exceptional resources and an outstanding mentoring team with proven success in developing junior clinician-scientists.